Slicing the health service cake: the Islington study

Little is known about the factors that are associated with receipt of care in older people. This study aims to describe the pattern and predictors of service usage, by a representative sample of people aged 65 and over.

We assessed psychiatric and physical morbidity, formal and informal care and prescribed medication by standardized questionnaires.

1085 people were interviewed at home. Having dementia was a negative predictor of GP and hospital consultation (both P<0.001). Depressed participants were most likely to consult with GPs (P<0.05); 13.1% were on antidepressants. People with dementia use health services less than their counterparts. The presence of co-resident informal caregivers predicts less use of social services but no increase in health consultations.

Carers give compensatory care rather than act as bridges to link people with dementia with the health care system. People with dementia need advocates. Older people with depression are high users of all services. They remain under-treated pharmacologically.